1 / 20

Mushrooms

Mushrooms. Hussein Unwala , Dr. Ingrid Vicas February 4, 2010. Objectives . Pretest Overview of Different Classes Approach to clinical classification Management of the unknown mushroom ingestion Cases. Mushroom Groups. Ten are identifiable: Cyclopeptides Gyromitrin Muscarine

madra
Télécharger la présentation

Mushrooms

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mushrooms Hussein Unwala, Dr. Ingrid Vicas February 4, 2010

  2. Objectives • Pretest • Overview of Different Classes • Approach to clinical classification • Management of the unknown mushroom ingestion • Cases

  3. Mushroom Groups • Ten are identifiable: • Cyclopeptides • Gyromitrin • Muscarine • Coprine • ibotenic acid and muscimol • psilocybin • general GI irritants • Orellinine • allenicnorleucine • Myotoxins

  4. Group I -- Cyclopeptides • Amanita species, including  A. verna, A. virosa, and A. phalloides • Galerinaspp, including G. autumnalis, G. marginata,andGalerinavenenata • Lepiota species, including L. helveola, L. josserandi, and L. brunneoincarnata.

  5. Cyclopeptides -- Clinical • Phase 1: • Severe gastroenteritis, 5-24 hours post ingestion • Phase 2: • Quiescent phase, 12-36 hours post ingestion • Phase 3: • Hepatic, renal toxicity, death; 2-5 days post ingestion • Endocrine malfunction - TSH, Ca, Insulin

  6. Cyclopeptides – Management • Activated charcoal 1g/kg q 2-4 hours, antiemetics • Correct fluid, electrolyte abnormalities • Forced diuresis and hemodialysis techniques • Penicillin G 1g/kg/day IV, administered 5 days post ingestion • Silibinin 20-50 mg/kg/day • May modify cell membrane receptor sites • safe • Worked in dogs, but . . . • Extracorporeal albumin dialysis as a bridge to liver transplant

  7. Group II - Gyromitra • Gyromitrin • Monomethydrazine • (Inhibits pyridoxine) Disrupts GABA

  8. Gyromitra – Clinical • Common : GI toxicity 5-10 hours post ingestion • Rare: • delirium, stupor, convulsions, coma • Hepatorenal syndrome

  9. Gyromitra -- Management • Activated Charcoal 1g/kg • Benzo’s for seizures • Pyrodixine 70mg/kg

  10. Group III -- Muscarine • SLUDGEM/DUMBELLS • No central muscarinic effects • Usually mild effects, develop 0.5-2hrs post • Atropine rarely needed

  11. Group IV -- Coprine • Disulfuram effect, inhibiting acetaldehyde dehydrogenase for up to 48-72 hours EtOH Alcohol Dehydrogenase Acetaldehyde Acetaldehyde Dehydrogenase Acetic Acid • tachycardia, flushing, nausea, and vomiting • Fomepizole theoretic benefit

  12. Group V – Ibotenic Acid/Muscimol • GABAergic in adults, • Somnolence, hallucinations, dysphoria, delerium • Glumatamatergic in kids • Myoclonic movements, seizures • Onset 0.5-2hrs • Benzoprn • http://www.youtube.com/watch?v=MkCS9ePWuLU

  13. Group VI-- Psylocybin • Aka magic mushrooms • Toxicity common • Thought to act at 5-HT2 receptors • Rapidly (within 1 hour) : ataxia, hyperkinesis, visual hallucinations, and illusions. • Rare : renal failure, seizures, cardiopulmonary arrest • Benzoprn

  14. Group VII – GI Toxins • Hundreds of mushrooms fall in this group (“Little Brown Mushrooms”) • GI toxicity occurs 0.5-3 hours post ingestion; clinical course is brief (6-24hours) • Rare : hypovolemic shock, immune-mediated hemolytic anemia • Supportive care

  15. Group VIII – Orelline/Orellanine • Nephrotoxic • Symptoms 24-36 hours post ingestion: headache, chills, flank/abdo pain, polydypsia, anorexia, nausea/vomitting • Oliguric renal failure develops several days to weeks later • Treatment : hemodialysis, renal transplantation. • No evidence suggests plasmapheresis/hemoperfusion is of any benefit in preventing chronic renal failure even when initiated in the first 48 hours.

  16. Group IX AllenicNorleucine • Associated with ingestion of Amanita smithiana • Symptoms noted 30min – 12hours • Often GI initially • Then ARF 4-6 days later, azotemia • Suggest treat with activated charcoal, early hemodialysis

  17. Group X: Rhabdomyolysis-Associated • All reported cases in Europe • Tricholomaequestre • All 15 cases led to subsequent death

  18. The unknown mushroom • Determine whether ingestion was a deadly variety; ieAmatotoxin • if outside southwestern Canada, onset of GI symptoms within 3 hours rules out amatoxin • Attempt collection of mushrooms, detailed description • Dry paper bag; gastric contents? • Consult a mycologist! If not available, • Melzer reagent : 20mL H20, 1.5g KI, 0.5g I, 20g chloral hydrate. Amatoxin turns dark blue upon contact

  19. Amanita Smithsianacan present 0.5-12 hours Mixed Ingestions can present any time

  20. Cases . . .

More Related